As kids head back to school, pediatricians are reminding parents that up to date vaccinations are required by the state. For some, it’s a routine part of the season, for others, a time to grapple with a decision determining the safety of their children.
There are passionate parents and physicians on both sides of the vaccine divide, but they do have commonalities. They each want the best for West Virginia’s children, and they want parents to be educated about inoculation.
It is no secret that West Virginia has some of the worst health outcomes in the country. Residents of the Mountain State are accustomed to seeing the state ranked high in diabetes, heart disease, obesity, rates of tobacco use and more.
West Virginia also lags behind in vaccination rates for very young kids. According to 2021 data, West Virginia’s childhood vaccination rate was the lowest in the country at 56.6 percent.
However, there is one aspect of health where the state leads the nation: school-age childhood vaccination rates.
Kids cannot attend school in West Virginia unless they are vaccinated against Diphtheria, Pertussis, Tetanus, Polio, Measles/mumps/rubella, chickenpox and Hepatitis B.
Dr. Jennifer Gerlach is a pediatrician and associate professor at Marshall Health and the president of the West Virginia Chapter of the American Academy of Pediatrics.
“If you look at West Virginia’s immunization rates before school, our young children, we have one of the lowest rates of vaccines in the country,” Gerlach said. “But then when children hit the West Virginia school system, we have one of the highest rates of immunizations, and that fact protects all West Virginians of all ages, because our school immunization policy is so strong.”
The only exceptions are rare circumstances where parents can show their child has an allergy to an ingredient in a vaccine, or is taking medication, such as certain cancer treatments, that weakens their immune system. Medical exemptions are rare and require both a letter from a doctor and approval from the state immunization officer.
But that strict policy and high vaccination rate, a bragging right for some, is for others a constraint of parental choice.
Chanda Adkins is a pharmacist, former state delegate and member of West Virginians for Health Freedom (WVHF), an organization that “advocates for legislative policies that recognize parental choice without discrimination.”
“We’re one of five that don’t have a religious exemption,” Adkins said. “So when you look at Appalachia, we’re kind of like this little island in the middle.”
At a coffee shop in Beckley, West Virginia, Adkins explained her stance on vaccination and the problems she has with West Virginia’s vaccination policy.
“When I think of health freedom, I think that someone has the ability to choose any kind of medical procedure, medication, anything that will affect their health they can have the freedom to choose to get the information and to make an informed choice decision about that,” Adkins said.
Adkins says shots should not be required and believes the process to obtain a medical exemption is too strict.
“Obviously, I don’t want any mandates,” Adkins said. “Most of the states in the country have mandates [that] say to come to school, you have to do this, but they have the exemptions.”
She believes physicians are dismissive of concerns from parents about possible vaccine side effects and that the child’s parent should be considered the expert, no matter the situation.
“I’m a residency-trained pharmacist, you know, I’m educated,” Adkins said. “How dare you talk about these people this way? Or just because they may not have medical degrees, but they know their children better than you do.”
Based on concerns like this, during the 2024 legislative session, state lawmakers passed a bill that would have loosened West Virginia’s school-entry vaccine requirements for virtual public school students and private school students.
The bill was vetoed by Gov. Jim Justice who said he was convinced by an outpouring of opposition to the bill from the state’s medical community.
Dr. Lisa Costello is a pediatric hospitalist at West Virginia University Children’s Hospital. She is also the immediate past president of the West Virginia State Medical Association and the West Virginia Chapter of the American Academy of Pediatrics.
Costello was one of the physicians who advocated to keep the current requirements in place.
“Giving people the opportunity to loosen, weaken our immunization policy opens up the door for preventable, debilitating diseases to come back in,” Costello said.
Unlike surrounding states, West Virginia has not had an outbreak of a vaccine-preventable disease in decades.
But in April this year, the state did see its first case of measles since 2009, when an “under-vaccinated” individual in Morgantown came back from an overseas trip. That case was contained to one person, though more than 150 people were exposed. State health experts said that only West Virginia’s herd immunity – the fact that so many people are vaccinated – kept it from becoming an outbreak.
Herd immunity means a large enough part of the population is vaccinated or has been infected so that a particular virus can never get a foothold.
“Herd immunity is a slang term used to denote a threshold of when enough individuals in a herd are immunized such that the disease does not have enough hosts to spread from person to person,” said Dr. Steven Eshenaur, health officer and executive director of the Kanawha-Charleston Health Department. “Unfortunately, the thresholds are very, very low to lose herd immunity.”
Gerlach said she is happy to discuss concerns with parents.
“As a pediatrician, I really want this to be a running conversation with my patients and their parents, if they are worried or concerned, I want to talk about it, and I want to keep talking about it,” Gerlach said.
Brooke Sargent is a nurse practitioner and parent of a one-year-old. She said she is supportive of vaccines but has family members who are hesitant to vaccinate, and said other providers did listen to those concerns.
“They’ve kind of just delayed them a little bit, and they’ve been respectful, kind of how they felt about that,” Sargent said.
When asked if she thinks the push to weaken school-entry vaccination policies in West Virginia is coming from parents or politics, Sargent responded, “That’s a tougher question. I think the push primarily is coming from parents more than political just kind of feeling like, ‘Why risk anything if we don’t have to?’”
Some parents have a myriad of concerns about vaccination. People like Chanda Adkins fear adverse events or side effects may injure their child rather than protect them.
“Some people may want the law changed because they want to send their kids to school,” Adkins said. “Some people may want the law change because they’re very afraid of a vaccine injury. Some people may want the law changed because their deeply held religious beliefs prohibit them from participating in this Act and their children don’t have certain opportunities because they won’t do that.”
Dr. Andrea Lauffer is a hospitalist and pediatrician at Thomas Health. She said the most common side effect of a vaccine is an injection site reaction that dissipates in a day or so.
“Certainly, are there rarities that occur, they are so rare but so rare that I have yet to see it in my clinical experience,” Lauffer said.
Adkins said WVHF wants to be seen as a community of people who don’t want to see bad things happen.
“We’re just West Virginians,” Adkins said. “We’re not crazy. We’re educated. And we love people. And we want to see our kids thrive. And we want to see families and people come behind us and thrive. And it’s not because we want anybody to catch a disease.”
Throughout the day we spent in the pediatrician’s office, Dr. Tim Lefeber, a general pediatrician and associate professor of Pediatrics at West Virginia University asked each family that visited his office if they would be willing to speak to our station about their vaccination beliefs. All but two, who are nurses at the hospital, declined.
The debate isn’t over. Vaccine skeptics in the legislature have vowed to try again to loosen requirements in 2025.
Before Justice vetoed the bill to loosen vaccine law in West Virginia, state Sen. Mike Stuart, R-Kanawha, posted on X that if the bill was vetoed, there would be a push from conservatives in the legislature for a new bill to allow for religious exemptions in 2025.
Lauffer said West Virginia’s medical community will pay close attention to the next legislative session and continue to advocate for strong vaccination laws.
“Immunizations have a ripple effect, and that they protect the patient, and then they protect others around the patient,” Lauffer said. “And so I do think that this will, if this is brought up again, which I think it will be, I think that there will be another response to remind our policymakers that this could be a threat to the health and well-being of West Virginians.”
Editor’s Note: This story is part of a series we’re calling “Public Health, Public Trust,” running through August. It is a collaboration with the Global Health Reporting Center and is supported by the Pulitzer Center.